An image of a finger test for blood glucose levels.


The History and Influence of the ADA

The American Diabetes Association (ADA) has been at the forefront of diabetes care and advocacy for decades. With the pervasive influence it holds over the $4 trillion U.S. healthcare system, understanding the ADA’s approach, particularly in terms of dietary recommendations, is crucial. Often, the spotlight on the ADA diet reveals a complex interplay of advocacy, science, and big business.

As we delve deeper, we’ll explore how the ADA’s dietary guidelines have evolved and the impact they have on managing diabetes effectively.

Founded with the noble intention of combating diabetes through research, education, and advocacy, the American Diabetes Association (ADA) has grown into the world’s most powerful diabetes advocacy group. Diabetes, affecting 38 million Americans and claiming over 100,000 lives annually, poses a significant public health challenge. The cost associated with managing diabetes—spanning doctor visits, medications, and more—totals about $400 billion each year. Amidst this, the ADA’s role in shaping healthcare policies and practices around diabetes management has been pivotal.


The ADA’s Approach to Diabetes Management

From its inception, the ADA has been instrumental in setting the standard for diabetes care. However, the organization’s stance on diet, particularly the ADA diet, has often been seen as conservative and closely aligned with pharmaceutical interests. In 2020, a seismic shift occurred when then-ADA president, Tracey D. Brown, revealed her personal success with a low-carbohydrate diet in managing her type 2 diabetes. This admission sparked a broader discussion about the effectiveness of low-carb diets and brought to light the ADA’s potential conflicts of interest with its pharmaceutical benefactors.

The ADA diet traditionally emphasized balanced carbohydrate intake without outright endorsing lower carbohydrate options that could significantly impact blood sugar levels. This stance has often been at odds with emerging nutritional studies that highlight the benefits of a low-carb diet for diabetes reversal. The revelation by an ADA president advocating for a diet contrary to the organization’s public guidelines marked a critical moment in the ongoing debate about the best dietary approach for diabetes management.



In 2020, a seismic shift occurred when then-ADA president, Tracey D. Brown, revealed her personal success with a low-carbohydrate diet in managing her type 2 diabetes.


Transitioning to a Science-Backed Approach

Despite the controversies, the ADA has begun to acknowledge the benefits of low-carbohydrate diets. Quietly, in 2019, the organization updated its dietary guidelines in the journal Diabetes Care, giving low-carb diets a nod for their effectiveness in reducing dependency on antihyperglycemic medications and managing blood sugar levels. This was a significant step towards aligning the ADA diet more closely with scientific evidence, showcasing a shift from a one-size-fits-all dietary recommendation to a more individualized approach to diabetes management.


The Case for Low-Carb Diets in Diabetes Management

The idea that a low-carbohydrate diet could significantly impact diabetes management is far from new. Historical accounts and modern research alike support the notion that reducing carbohydrate intake can dramatically improve the health outcomes of those with diabetes.


A wide variety of low carbohydrate foods.
Recent scientific studies have consistently shown that low-carbohydrate diets can significantly decrease the need for medications and help maintain more stable blood sugar levels in diabetics.


Historical Perspectives on Low-Carb Diets

Long before the discovery of insulin in 1921, doctors recommended very low-carb, fat-rich diets to manage diabetes, a practice that dates back to the late 18th century. For instance, Scottish doctor John Rollo successfully treated diabetes by restricting carbohydrate intake, a method documented in medical literature as early as 1797. These early practices underline the longstanding recognition of the relationship between carbohydrate consumption and blood sugar levels.


Modern Scientific Endorsement of Low-Carb Diets

Recent scientific studies have consistently shown that low-carbohydrate diets can significantly decrease the need for medications and help maintain more stable blood sugar levels in diabetics. This recognition has started to reflect in the guidelines of several health organizations beyond the ADA, underlining a global shift towards embracing the benefits of reduced carbohydrate intake for diabetes management.


International Endorsements and Studies

  1. World Health Organization (WHO): In its reports, WHO has recognized the potential benefits of low-carb diets in managing diabetes, noting that reducing carbohydrate intake can improve glycemic control and reduce the need for blood sugar-lowering medications.
  2. National Health Service (NHS) UK: The NHS has begun to acknowledge the role of low-carbohydrate diets in diabetes management. They provide resources for healthcare professionals to support patients in implementing low-carb diets effectively, citing studies that demonstrate improved blood sugar levels and reduced dependency on medications.
  3. The Dietitians Association of Australia (DAA): The DAA offers guidelines that include low-carb diets as a viable option for diabetes management, suggesting personalized nutrition plans based on individual health needs and preferences.


Academic Research and Publications

Several pivotal studies published in reputable medical journals have also supported the shift toward low-carb diets:

  1. The New England Journal of Medicine published a study demonstrating that participants on low-carb diets saw significant improvements in blood glucose control and a reduction in diabetes medications compared to those on high-carb diets.
  2. Journal of the American Medical Association (JAMA) featured research indicating that low-carb diets could not only help control blood sugar levels but also contribute to weight loss and improved heart health among diabetics.
  3. Lancet Diabetes & Endocrinology released a meta-analysis showing that low-carb diets are more effective in achieving glycemic control in diabetics than conventional high-carb diets.


The ADA Diet: Contradictions and Controversies

Despite accumulating evidence and changing guidelines, the ADA’s messaging on low-carb diets has often been inconsistent and fraught with controversy.


The Influence of Corporate Funding in the ADA Diet

The ADA’s significant corporate funding from pharmaceutical and food industries raises concerns about potential conflicts of interest, particularly in how dietary guidelines are shaped. Critics argue that the organization’s cautious stance on low-carb diets may be influenced more by corporate partnerships than by unbiased scientific discovery. This conflict is particularly evident in the ADA’s promotional activities, which often emphasize pharmaceutical solutions over dietary management.


An older woman is organizing her diabetes medication at her kitchen table.
The ADA’s promotional activities often emphasize pharmaceutical solutions over dietary management.


Mixed Messages on Carbohydrates

The ADA’s website exemplifies the confusion surrounding carbohydrates, offering mixed messages that can leave diabetes patients unsure about the best approach to managing their condition. While acknowledging the impact of carbs on blood sugar, the ADA stops short of advocating strongly for reduced carbohydrate intake, maintaining a balanced view that includes moderate carb consumption.


Voices from Within and Beyond the ADA

Tracey D. Brown’s personal testament to the benefits of a low-carb diet provides a powerful narrative from within the ADA’s leadership. Similarly, healthcare professionals like Harvard-trained endocrinologist Mariela Glandt advocate for a low-carb approach, citing its effectiveness in treating type 2 diabetes without the long-term complications associated with insulin therapy.


The Broader Impact of ADA’s Diet Guidelines

The ADA’s influence extends far beyond the borders of the United States, shaping diabetes management practices around the globe. Understanding the full impact of the ADA diet and its guidelines is crucial for assessing both the challenges and opportunities in improving diabetes care worldwide.


Global Reach of ADA Standards

The ADA’s Standards of Care are revered and followed by healthcare providers across the world. These guidelines dictate a wide range of practices, from dietary recommendations to medication protocols. The organization’s reach, supported by its extensive network and substantial funding, positions it as a key player in the international healthcare landscape. However, this influence also means that any limitations or biases in ADA guidelines can have widespread effects.


Economic and Health Outcomes

The financial and health ramifications of diabetes are profound. With diabetes-related expenses accounting for a significant portion of healthcare spending, the ADA’s recommendations have economic implications that extend into the billions of dollars. In addition, the human cost, in terms of quality of life and diabetes-related complications, is enormous. Effective dietary management strategies, such as those endorsed by the ADA, could potentially reduce these costs dramatically by decreasing reliance on medication and managing diabetes more naturally.


Final Thoughts on the ADA Diet

The ADA diet and the broader dietary guidelines proposed by the American Diabetes Association represent more than just clinical advice.  The ADA are cornerstone of diabetes management that affects millions of lives. As we have seen, while the ADA has begun to acknowledge the benefits of low-carbohydrate diets, there remains a gap between scientific evidence and the guidelines promoted.


While the ADA has begun to acknowledge the benefits of low-carbohydrate diets, there remains a gap between scientific evidence and the guidelines promoted.


Need for Transparency and Adaptation in the ADA Diet

For the ADA to maintain its role as a leader in diabetes care, it must continuously adapt its guidelines. It should do this based on the latest scientific evidence and reduce the influence of corporate partnerships in its educational and advocacy efforts. Promoting a diet that genuinely benefits diabetic patients rather than pharmaceutical or food industry partners is essential for the credibility and effectiveness of the ADA.


The Potential for Dietary Management

There is a compelling case for the ADA to more strongly advocate for low-carbohydrate diets as part of diabetes management. By doing so, the organization could dramatically shift the narrative from managing symptoms to potentially reversing type 2 diabetes.  This action would reduce the disease’s impact on individuals and healthcare systems alike.


A Call to Action

It is imperative for the ADA to lead with boldness and clarity, especially when it comes to dietary recommendations. Informing patients about all viable options, including the significant benefits of a low-carb diet, can empower them.  It allows them to make choices that might not only manage but also alter the course of their disease. By prioritizing patient health over industry ties, the ADA can fulfill its mission more effectively, improving outcomes for diabetics worldwide.

As this discussion highlights, the journey toward optimal diabetes management is complex and fraught with challenges. However, the potential rewards—a healthier population and reduced healthcare costs—are too significant to ignore. The ADA, with its powerful platform and resources, has the opportunity to lead this change, making a substantial difference in the lives of millions.



  • New American Diabetes Association Report Finds Annual Costs of Diabetes to be $412.9 Billion. ADA
  • Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report. ADA
  • Previous Reports and Financials. ADA
  • The Hidden Hand: Big Pharma’s Influence on Patient Advocacy Groups. Patients for Affordable Drugs (PDF)
  • The insulin market reaches 100. PubMed
  • The High Cost of Diabetes Drugs: Disparate Impact on the Most Vulnerable Patients. PubMed


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Laurie Tsemak is the founder and co-owner of PowerFlax Holdings Inc. and Red Square Bakery. Laurie and her husband, Mark have spent 34 years in the wholesale and retail baking field, focusing on innovative product development to serve health-conscious customers and forward-thinking commercial bakeries.

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